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Head injury assessment adopted into law

By Aidan Berry
February 14 2018

World Rugby has adopted temporary substitution for head injuries at the elite level into Law 3.10, further underscoring the governing body’s commitment to evidence-based research driving player welfare enhancements for players at all levels of the sport. World Rugby's number-one priority is player welfare and any clear signs or symptoms of concussion or suspected concussion - at all levels of the game - must result in the immediate and permanent removal of players from the playing or training environment as highlighted within the organisation's #RecogniseAndRemove education campaign.     

The temporary substitution time period has proven successful in assisting medical staff to assess and make an informed decision regarding the removal of players when suspected concussion is not clear. The entire process includes strict side-line assessment based on the best available evidence and rigid follow-up procedures. 

This HIA tool combines cognitive, balance and memory tests and is derived from the SCAT 3 recommended by the experts from the Zurich Concussion Consensus Group to assist medics in making the correct decision following a head impact. World Rugby is the first sport to use access to an on-field law to obtain post-injury management compliance resulting in improved diagnostic accuracy of concussion and improved player safety. 

World Rugby Chief Medical Officer Dr Martin Raftery said: "World Rugby's number-one priority is player welfare and allowing temporary substitution for head injury has proven to be a massive step forward in protecting our elite players following a head injury. 

"As someone who has been involved as a team doctor in elite sport for more than 25 years, I firmly believe that medical management of concussion in rugby has never been stronger. Law changes, pitch-side and post-injury management, combined with greater education and awareness are ensuring that we continue to put our players first." 


  • Any clear or suspected signs or symptoms of concussion MUST result in immediate and permanent player removal
  • If the signs or symptoms of concussion are unclear then a player can be removed for an HIA, which is a 10-minute off-field assessment - the HIA does not diagnose concussion, it identifies a suspected concussion
  • If a player is suspected of concussion following a pitch-side assessment supported by the HIA they are removed permanently from the match
  • Any player who undertakes an HIA (irrespective of the result) must undertake a further clinical assessment supported by the SCAT 3 immediately after the match and again at 36-48 hours – it is during this period that the diagnosis occurs
  • Any player with a concussion must undertake a supervised graduated return to play protocol to manage safe return to competition



Link to World Rugby article

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